Presence of right ventricular (RV) dysfunction is an adverse prognostic indicator but current echocardiographic methods have some limitations.
RV apical angles in systole and diastole were correlated with known parameters of RV function in patients without pulmonary hypertension (Group 1) and in patients with pulmonary hypertension (Group 2). RV apical angles were significantly smaller in both systole (22 + 7 degrees) and diastole (33 + 6 degrees) in Group 1 patients when compared to Group 2 (54 + 18 degrees, p<0.0001 and 59 + 17 degrees, p<0.0001, respectively).
Group 2 patients had statistically larger RV systolic and diastolic areas (19± 9 versus 8 ± 3 and 27± 9 versus 17 ± 3, p<0.0001; respectively) and smaller maximal TV annular excursion (2.5 ± 0.44 versus 1.5 ± 0.66, p< 0.00001; respectively) than Group 1. Group 2 had statistically larger RV apical angles in both systole and diastole when compared to Group 1 (54 ± 18 and 59 ± 17 versus 22 ± 7 and 33 ± 6, p< 0.00001, respectively). The peak pulmonary systolic pressures were not only inversely correlated with RVFAC (R = -0.62; p<0.001) but also with maximal TV annular excursion (R = -0.69; p<0.001). A very strong linear correlation was noted between the RVEDA and RV diastolic apical angle (R = 0.81, p<0.0001) and between the RVESA and RV systolic apical angle (R = 0.89, p<0.0001). RV apical angle also had a statistically significant inverse correlation with measures of RV function. A representative end diastolic four chamber still frame image of a normal and a patient with an abnormal RV apical angle is shown.
Therefore, we conclude that this new measurement of RV apical angle is simple and useful to quantify RV apical structural and functional abnormalities that are well correlated with global RV impairment in patients with chronic pulmonary hypertension.
Ease of data acquisition, reproducibility, and lack of cumbersome geometric analyses allow for easy clinical application.
Angel Lopez-Candales, None.